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Provider Management

See the value of strategically managed data

The lack of comprehensive and accurate provider information is one of the largest problems facing healthcare payers today and one of the primary reasons that claims fall out of the auto adjudication process. As physicians move or provide services from different locations, provider data quickly becomes inaccurate or incomplete – a problem that is amplified by an increase in mergers of hospitals and provider networks.

To ensure their profitability, provider relationships, and regulatory compliance, healthcare payers must take a more strategic approach to managing provider data across the enterprise. In many cases, these organizations maintain multiple versions of provider databases that are owned and managed by different entities. The result is a collection of disparate systems, redundant efforts, and inconsistent information. A single, accurate, updated source of provider information means better, faster claims processing; improved reporting and compliance; and increased efficiency across claims processes and network management.

Proactively manage provider data to improve the bottom line

Ajilitee’s Provider Data Management Services are designed to deliver more accurate, current and consistent provider data to fuel processes such as credentialing, demographics, contract and pricing, relationship management, and network management. We offer a variety of strategy services and workshops to help payers integrate provider data across all sources to overcome challenges that stem from inconsistent or inaccurate provider data. Ajilitee provides in-depth services that help payers plan, architect and develop the following provider data management solutions:

  • Integrate, cleanse and transform disparate provider data in a centralized, transactional repository that allows effective provider information management and automated interfaces with other systems (claims payment, provider reporting, etc.)
  • Build an enterprise Provider Reporting and Analytics Hub that will focus on providing required reporting and insights to action
  • Assist with provider data governance that will institute policies for guiding the use of provider data, establish decision rules, document provider data definitions and processes and assign data stewards to manage data quality, availability, archive and access control

Get your provider data management solution to market faster with our healthcare-focused accelerators

A collection of business and technology accelerators leverage the experience across our healthcare client network to greatly improve speed to market and reduce overall project risk.

  • Business requirements and key performance indicators: Get to your implementation faster by starting with base level requirements captured and refined from across our healthcare client work. We’ll help you tailor them to meet your specific business needs.
  • Data quality framework: Apply a consistent, objective approach to provider data quality, using our comprehensive approach, which includes data governance/data stewardship, data integration, master data management, and metadata management.
  • Reference architecture and data models: Our predefined models give you a starting point that you can tailor for your provider data environment and business needs. They promote speed to market, reusability, consistency, standards, architectural governance, reduced cost of ownership, and a single version of the truth.
  • Data governance framework: Use our framework to help define how your organization will manage the collection, availability, integrity, use, and security of provider data across entities. Our framework provides you with templates for your mission statement, policy creation, and process flow; defines suggested roles and responsibilities; and outlines workflows, data flows, pain points, and much more.

Business value of a strong provider data foundation

Reduce expenses: Apply discounts per the contract, reduce ongoing costs of preparing directory files, improve claims auto adjudication rates, improve operational efficiencies, reduce pended claims, detect fraud and take immediate action, reduce returned mail expenses
Avoid expenses: Avoid labor costs to support claims fallout and member service, bypass labor costs for additions and corrections to provider records, circumvent regulatory non-compliance costs, avoid future redundant data and systems
Improve member and provider satisfaction Improve access to care, improve provider relationships, differentiate the member experience
Improve management insights: Improve quality of decision data and speed of access to decision data

 

Recognized

Inc 5000 2014 LaunchPoint 100

Inc. magazine has ranked LaunchPoint, parent company of Ajilitee, #100 in its 2014 Inc. 5000 list of fastest-growing privately held companies in the U.S.

According to the Association of Health Insurance Plans (AHIP), incomplete or inaccurate provider data is a culprit in driving up the cost of processing a claim from $.99 for an auto adjudicated claim to $3.99 for a pended or delayed claim.

Source:  AHIP press release: “Rise in Electronic Claims Submission Speeds Up Receipt, Processing Time,” February 5, 2013.